by Shelley DuBois, The Tennessean

by Shelley DuBois, The Tennessean

NASHVILLE, Tenn. -- Few Americans, given the choice, would buy health insurance over a Christmas present.

And yet, the open enrollment period for federal Marketplace plans on Healthcare.gov coincides with the winter holidays, one of the most financially stressful times of the year. That's why researchers suggest switching the open enrollment period to line up with a less stressful time. Namely, in spring, just after people have received their tax return.

The study, published Wednesday in the journal Health Affairs was co-authored by Katherine Swartz, a professor at Harvard's health policy and management department, and John Graves, an assistant professor at Vanderbilt University's medical school.

The methodology is interesting in and of itself - the authors looked at Google query data to see when people searched for certain terms, including health insurance. Previous studies have used Google query data, too. One, published in the journal Clinical Infectious Diseases, said that Google searches for flu symptoms could predict an influenza outbreak about seven to 10 days faster than the CDC.

This study looked at annual patterns in Google queries between January 2004 and December 2013. It found that during the winter holiday season - which is typically open enrollment season for health insurance - people searched for terms such as "payday loan" and "cash advance" that indicated they needed financial help. People did not search for health care information in the middle of winter, when they had other financial stressors. During the time when people would have been getting their tax return, the researchers saw a higher incidence of queries for health insurance.

Beyond the holiday stress, many low-income people have a very real reason for holding off on purchasing health insurance until they get their tax return - that is, they may not know their expendable income until they do.

"You're talking about something that is a central transaction in the annual financial calendar of Americans," said George Brandes, vice president of health care programs at tax firm Jackson Hewitt, which has a history of collaborating with the authors on research projects. "This is the largest injection of liquidity into consumers' hands ever year."

According to a 2014 report by the Urban Institute, 75 percent Americans receive a tax refund, and the average amount is $3,000.

Lower-income Americans who qualify for a subsidy tend to seek help from financial advisers. When they do, the study authors argue, that's a good time to talk about health insurance. For one, because the penalty for being uninsured shows up as a tax, something that a financial adviser would know about. Second, people tend to want the same help purchasing health insurance that they do making other financial decisions.

"Unlike those of us who get coverage through our employer, (people eligible for a subsidy on the exchange) are choosing among, in some cases, hundreds of plans, so it's a very complex process," Graves said.

Advisers at Jackson Hewitt fielded questions from low-income clients about health insurance last year, Brandes said. "If you're having that penalty conversation when it's too late to sign up, then the whole design of the penalty as a public policy tool is defeated," he said.

"You just make a lot of people mad. We don't want to be the bearer of bad news with no remedy. We want to be able to offer our customers a way to avoid the penalty next year."

This would be a simple fix, Swartz said. The Department of Health and Human Services has some flexibility in determining the open enrollment period, as we know, since HHS extended it several times this past year. HHS' proposed open enrollment period for 2015 is Nov. 15, 2014-Feb. 15, 2015.

Shifting the open enrollment period later would not require a huge influx of capital, nor an act of Congress, the authors argue. Instead, they say, the change makes sense when you consider the purchasing behavior of people who stand to benefit the most from subsidized Marketplace plans.